Sullivan County Residential Safe Room Application

Sullivan County Residential Safe Room Application

This application does not guarantee funding for a safe room and is not an application for assistance. Please provide all of the information requested. Incomplete forms will not be retained for consideration. If selected, you will be notified and provided additional documentation for signature and acceptance.

The application deadline is April 22, 2025.

Terms and Conditions

By submitting this application, you are verifying that the information you are providing is correct and you understand and agree to the following terms and conditions.

I understand that completion and submission of this application is not a guarantee of selection for the program.*

Yes

No

STOP! You selected No to the previous term or condition.

Thanks for your interest, but all terms and conditions must be agreed to in order to be eligible for this program. Do not submit this application, as it will not be considered.

Only one person from a residence (must be the homeowner and landowner) can apply for selection for the program.*

Yes

No

STOP! You selected No to the previous term or condition.

Thanks for your interest, but all terms and conditions must be agreed to in order to be eligible for this program. Do not submit this application, as it will not be considered.

No safe room installation can begin until final award notification is received from IDHS. I also understand safe rooms previously installed or in the process of being installed are not eligible for reimbursement in the program.*

Yes

No

STOP! You selected No to the previous term or condition.

Thanks for your interest, but all terms and conditions must be agreed to in order to be eligible for this program. Do not submit this application, as it will not be considered.

Any safe room installation must be compliant with FEMA Publication 320 and/or 361.*

Yes

No

STOP! You selected No to the previous term or condition.

Thanks for your interest, but all terms and conditions must be agreed to in order to be eligible for this program. Do not submit this application, as it will not be considered.

The safe room types eligible for installation in the program will consist only of prefabricated shelters suitable for installation in above-ground and/or below-ground locations within the homeowner's residence (including garage) or outdoors within 100 feet of the foundation of the residence.*

Yes

No

STOP! You selected No to the previous term or condition.

Thanks for your interest, but all terms and conditions must be agreed to in order to be eligible for this program. Do not submit this application, as it will not be considered.

Selected homeowners are eligible for a rebate of up to 75 percent of the actual cost to install a safe room at their residence. I understand that I am responsible for all up-front costs and will be reimbursed for 75 percent of the total costs, up to a maximum rebate amount of $5,000.*

Yes

No

STOP! You selected No to the previous term or condition.

Thanks for your interest, but all terms and conditions must be agreed to in order to be eligible for this program. Do not submit this application, as it will not be considered.

If selected for the program, I understand that I will not receive any funds until all requirements of the Indiana Residential Safe Room Rebate Program are met.*

Yes

No

STOP! You selected No to the previous term or condition.

Thanks for your interest, but all terms and conditions must be agreed to in order to be eligible for this program. Do not submit this application, as it will not be considered.

If selected for the program, I agree to allow IDHS representatives to access my property to verify safe room installation is completed.*

Yes

No

STOP! You selected No to the previous term or condition.

Thanks for your interest, but all terms and conditions must be agreed to in order to be eligible for this program. Do not submit this application, as it will not be considered.

I am responsible for the future operation and maintenance of the safe room and will ensure that the safe room is maintained in a manner that allows for its intended use during a storm event.*

Yes

No

STOP! You selected No to the previous term or condition.

Thanks for your interest, but all terms and conditions must be agreed to in order to be eligible for this program. Do not submit this application, as it will not be considered.

I agree to not hold IDHS and/or FEMA responsible for any liabilities or claims caused by or resulting from the installation or operation of a safe room on my property.*

Yes

No

STOP! You selected No to the previous term or condition.

Thanks for your interest, but all terms and conditions must be agreed to in order to be eligible for this program. Do not submit this application, as it will not be considered.

Electronic Signature*

By entering your full name below, you acknowledge that you understand and agree to all the preceding terms and conditions.

Homeowner Information

Homeowner Name*

County*

Select

Property Address*

Mailing Address*

Tax ID/Parcel ID*

Enter "Unknown" if you do not know the property's tax ID or parcel ID.

Home Phone Number

Phone

Cell Phone Number

Phone

Email Address*

Do you own your home?*

Yes

No

Home Information

What type of home do you own?*

Mobile/manufactured home

House with basement

House without basement

Mobile/manufactured home: Do you own the land?*

Both the land and the mobile/manufactured home must be owned by the same occupant.

Yes

No

What year was your home built?*

Is your home located in a historic district?*

Yes

No

How many people live at the home?*

How many bedrooms are in the home?*

What type of safe room do you want to install?*

Interior Above-Ground

Exterior Above-Ground

Interior Below-Ground

Exterior Below-Ground

Is the home located in a flood zone?*

Yes

No

Unknown

Will the safe room be installed within 100 feet of the home's foundation?*

Yes

No

How did you hear about the Safe Room Program?*

Send me a copy of my responses

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